[Good practice for aerosol therapy by nebulization in 2020]. / Bonnes pratiques de l'aérosolthérapie par nébulisation en 2020.

Nebulization is a drug delivery mode whose prescription and application remain uncertain. A guide to good practice has been proposed by the work group on aerosol therapy of the French Society for Respiratory Diseases, so-called GAT. The previous recommendations date from 2007. In addition to an update of data on nebulization, these expert recommendations aim to be of real help to the prescriber.

[Use of pentamidine nebulization in children]. / Enquête sur l'utilisation des nébulisations de pentamidine en pédiatrie.

AIM: Pentamidine is a drug generally used for the prophylactic treatment of Pneumocystis pneumonia in immunocompromised patients. The Respirgard II® jet nebulizer has been recommended for pentamidine administration, but this device is no longer available. The aim of our study was to review current clinical practice for pentamidine nebulisation in paediatric hospitals. METHODS: A survey was sent to the departments of Haematology and Pneumology of university hospitals all over France. We collected information about treatment indications, the number of treated children in 2010, side effects and delivery devices used for nebulization. RESULTS: Out of the 62 interviewed departments, 36 responses were obtained (58 %). Half the respondents, mostly Haematology departments (n=15/18), used nebulized pentamidine in immunocompromised patients aged 5 to 15 years old who were unable to tolerate sulfamethoxazole-trimethoprim. Sixty-three percent of them treated less than ten children per year, with monthly 150 to 300mg doses administered over a period of 9 to 12 months. Few side effects were reported. In 61 % of the cases, the nebulizer used was unknown or not adapted (1 ultrasonic and 1 mesh nebulizer). In the remaining cases, pentamidine was nebulized with approved jet nebulizers (Isoneb®, Respiromed CR01®, and Microcirrus®). CONCLUSION: Nebulized pentamidine is not used frequently in children. Better information about the appropriateness of nebulizer usage is needed.

Inhaled insulin: a model for pulmonary systemic absorption?

The European Union recently approved a form of insulin intended to be inhaled. This innovative presentation has the potential to partially or completely replace the injections and thus facilitate starting insulin therapy which is considered with apprehension and often differed. On this occasion, we reviewed the issues raised by this pulmonary route for systemic absorption (anatomical and cytological limits, cellular mechanisms, relevant physical parameters, facilitating chemical cofactors, role of tobacco smoking and of common respiratory diseases). The pharmacokinetics of inhaled and injectable insulins are comparable, apart from an appreciably faster absorption of the former, and both show the same intra-individual variability. The total bioavailability is definitely lower with the inhaled route but is notably increased in smokers. These characteristics can vary according to the inhalation system used. A frequent induced cough, the increase in circulating anti-insulin antibodies, and a potentially higher cost are not really determining obstacles. The indications will have to be clearly specified and the long-term innocuousness of repeated inhalation of such a mitogen, especially in children and former smokers, remains to be fully proven.

[Inhaled insulin: a model for pulmonary systemic absorption?]. / L'insuline par voie inhalée: un modèle pour l'absorption systémique pulmonaire?

European Union has recently approved a form of insulin intended to be inhaled. This innovative presentation has the potential to partially or completely replace the injections and thus facilitate starting insulin therapy which is considered with apprehension and too often differed. On this occasion, we reviewed the issues raised by this pulmonary route for systemic absorption (anatomical and cytological limits, cellular mechanisms, relevant physical parameters, facilitating chemical cofactors, role of tobacco smoking and of common respiratory diseases). The pharmacokinetics of inhaled and injectable insulins are comparable, apart from an appreciably faster absorption of the former and both show the same intra-individual variability. The total biodisponibility is definitely lower with the inhaled way but it is notably increased in smokers. These characteristics can vary according to the inhalation system used. A frequent induced cough, the increase in circulating anti-insulin antibodies and a potentially higher cost are not really determining obstacles. The indications will have to be clearly specified and the long-term inocuity of long term inhalation of such a mitogene especially in children and former smokers remains to be formally proven.

[A survey of nebulization practices in France conducted in 2004 by the GAT]. / NUAGES: une enquête sur la pratique de la nébulisation en France.

METHODS: A questionnaire was sent to 50 000 general practicioners (GP) and specialists. RESULTS: 4,898 physicians (9.4%) responded, including 59.1% GP, 16.9% pneumologists, 13% pediatricians and about 10% other specialists, ENT, allergologists, and intensivists. The main reason for pneumologists to prescribe nebulization was the efficiency on long term of approved drugs. GP prescribe nebulization for its local effects, using unapproved drugs, on short periods of time, especially in COPD, asthma, bronchitis and tracheitis/laryningitis. Although pneumologists have been trained during their fellowship and do not ask for further education, MG have learned by their own experience and are asking for further education. CONCLUSION: This study should help to develop teaching programs on nebulization with the aim to optimize its practice.

N.U.A.G.E.S: a survey of nebulisation practice in France with regard to ERS guidelines.

UNLABELLED: A survey of nebulisation practice in France was conducted under the aegis of the French respiratory society in 2004. METHODS: Analysis of a questionnaire was obtained from 3674 physicians. RESULTS: A total of 2439 physicians were general practitioners (GPs), 698 were chest physicians, and 537 paediatricians. The main reasons to use nebulisation are (1) for chest physicians efficacy in treating various pathologies with long-term administration (1 wk to 1 month) of approved drugs, and (2) for GP's local action properties. While chest physicians learned about nebulisation during their university training and do not ask for additional information, GPs learned by practical experience or from colleagues and ask for further information. CONCLUSION: This study will help to develop targeted educational programmes on nebulisation practice.